Procedure and Transportation Codes Billing Limitations

Size: px
Start display at page:

Download "Procedure and Transportation Codes Billing Limitations"

Transcription

1 Procedure and Billing Limitations Treatment Services That Can Not be Billed on Same Day Procedure Psychotherapy, 30 minutes with patient and/or family member Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) * Indicates service may be allowable in addition to HCTC if billed with an override 1 and documented in the Client's medical record Revised 10/3/2013

2 Procedure and Billing Limitations Psychotherapy, 45 minutes with patient and/or family member That Can Not be Billed on Same Day Procedure Psychotherapy, 45 minutes with patient and/or family memberwhen performed with an evaluation and management service (list separately in addition to the code for primary procedure) * Indicates service may be allowable in addition to HCTC if billed with an override 2 and documented in the Client's medical record Revised 10/3/2013

3 Procedure and Billing Limitations Psychotherapy, 60 minutes with patient and/or family member That Can Not be Billed on Same Day Procedure Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) * Indicates service may be allowable in addition to HCTC if billed with an override 3 and documented in the Client's medical record Revised 10/3/2013

4 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Interactive complexity (list separately in addition to the code for primary procedure Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report * Indicates service may be allowable in addition to HCTC if billed with an override 4 and documented in the Client's medical record Revised 10/3/2013

5 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office or other outpatient visit for the evaluation and management of new patient, which requires these 3 key components: a problem-focused history; a problem-focused examination; and, straightforward medical decision-making. (Approx 10 min) Office or other outpatient visit for the evaluation and management of new patient, which requires these 3 key components: expanded problem-focused history; an expanded problem-focused exam; and straightforward medical decision-making. (Approx 20 min) * Indicates service may be allowable in addition to HCTC if billed with an override 5 and documented in the Client's medical record Revised 10/3/2013

6 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office or other outpatient visit for the evaluation and management of new patient, which requires these 3 key components: a detailed history; a detailed examination; and, medical decision-making of low complexity. (Approx 30 min) Office or other outpatient visit for the evaluation and management of new patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and, medical decision-making of moderate complexity. (Approx 45 min) * Indicates service may be allowable in addition to HCTC if billed with an override 6 and documented in the Client's medical record Revised 10/3/2013

7 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office or other outpatient visit for the evaluation and management of new patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and, medical decision-making of high complexity. (Approx 60 min) Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problems are minimal. Typically, 5 minutes are spent performing or supervising these services. * Indicates service may be allowable in addition to HCTC if billed with an override 7 and documented in the Client's medical record Revised 10/3/2013

8 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem-focused history; a problem-focused examination; straightforward medical decision-making. (Approx 10 min) Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem-focused history; an expanded problem-focused examination; medical decision-making of low complexity. (Approx 15 min) * Indicates service may be allowable in addition to HCTC if billed with an override 8 and documented in the Client's medical record Revised 10/3/2013

9 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision-making of moderate complexity. (Approx 25 min) Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a comprehensive history; a comprehensive examination; and medical decision-making of high complexity. (Approx 40 min) * Indicates service may be allowable in addition to HCTC if billed with an override 9 and documented in the Client's medical record Revised 10/3/2013

10 Procedure and Billing Limitations Observation care discharge day management. That Can Not be Billed on Same Day Procedure Initial observation care, per day, for the evaluation and management of a patient which requires the three key components: a detailed or comprehensive history; a detailed or comprehensive examination; and medical decision making that is straightforward or of low complexity. * Indicates service may be allowable in addition to HCTC if billed with an override 10 and documented in the Client's medical record Revised 10/3/2013

11 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Initial observation care, per day, for the evaluation and management of a patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity Initial observation care, per day, for the evaluation and management of a patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity. * Indicates service may be allowable in addition to HCTC if billed with an override 11 and documented in the Client's medical record Revised 10/3/2013

12 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office consultation for a new or established patient, which requires these 3 key components: a problem-focused history; a problem-focused examination; and medical decision-making for a minor presenting problem. (Approx. 15 minutes) Office consultation for a new or established patient, which requires these 3 key components: an expanded problem-focused history; an expanded problem-focused examination; and straightforward medical decision-making for problems of a low severity. (Approx. 30 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 12 and documented in the Client's medical record Revised 10/3/2013

13 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office consultation for a new or established patient, which requires these 3 key components: a detailed history; a detailed examination; and medical decision-making for a problem of low complexity. (Approx. 40 minutes) Office consultation for a new or established patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision-making of moderate complexity for problems of a moderate/high severity. (Approx. 60 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 13 and documented in the Client's medical record Revised 10/3/2013

14 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office consultation for a new or established patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision-making for a problem of a high severity. (Approx. 80 minutes) Emergency department visit for the evaluation and management of a patient, which requires these three key components: a problem-focused history; a problem-focused examination; and straightforward medical decision-making. Presenting problem(s) are self-limited or minor. * Indicates service may be allowable in addition to HCTC if billed with an override 14 and documented in the Client's medical record Revised 10/3/2013

15 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making for a problem of low complexity. Presenting problem(s) are of low to moderate severity Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making for a problem of moderate complexity. Presenting problem(s) are of moderate severity. * Indicates service may be allowable in addition to HCTC if billed with an override 15 and documented in the Client's medical record Revised 10/3/2013

16 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a detailed history; a detailed examination; and medical decision-making of moderate complexity. Presenting problem(s) are of high severity Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision- making of high complexity. Presenting problem(s) are of high severity. * Indicates service may be allowable in addition to HCTC if billed with an override 16 and documented in the Client's medical record Revised 10/3/2013

17 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Evaluation and management of a new or established patient involving an annual nursing facility assessment which requires these 3 components: a detailed interval history; a comprehensive examination; and medical decision making that is straightforward or of low complexity. (Approx. 30 minutes) Evaluation and management of a new or established patient involving a nursing facility assessment which requires these 3 components: a detailed interval history; a comprehensive examination; and medical decision making of moderate to high complexity. (Approx. 40 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 17 and documented in the Client's medical record Revised 10/3/2013

18 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Evaluation and management of a new or established patient involving a nursing facility assessment at the time of initial admission or readmission to the facility, which requires these three components: a comprehensive history; a comprehensive examination; and medical decision making of moderate to high complexity. (Approx. 50 minutes) Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components: a detailed or comprehensive history; a detailed or comprehensive examination; and medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem and the patient's and/or family's needs. Usually the problem(s) requiring admission are of low severity * Indicates service may be allowable in addition to HCTC if billed with an override 18 and documented in the Client's medical record Revised 10/3/2013

19 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. Usually, the problem(s) requiring admission are of moderate severity Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity. Usually, the problem(s) requiring admission are of high severity * Indicates service may be allowable in addition to HCTC if billed with an override 19 and documented in the Client's medical record Revised 10/3/2013

20 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a problem focused interval history; a problem focused examination; straightforward medical decision making. Usually the patient is stable, recovering, or improving Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of low complexity. Usually, the patient is responding inadequately to therapy or has developed a minor complication * Indicates service may be allowable in addition to HCTC if billed with an override 20 and documented in the Client's medical record Revised 10/3/2013

21 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a detailed interval history; a detailed examination; medical decision making of moderate complexity. Usually, the patient has developed a significant complication or a significant new problem Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a comprehensive interval history; a comprehensive examination; medical decision making of high complexity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention * Indicates service may be allowable in addition to HCTC if billed with an override 21 and documented in the Client's medical record Revised 10/3/2013

22 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Nursing facility discharge day management, 30 minutes or less Nursing facility discharge day management, more than 30 minutes * Indicates service may be allowable in addition to HCTC if billed with an override 22 and documented in the Client's medical record Revised 10/3/2013

23 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Evaluation and management of a patient involving an annual nursing facility assessment, which requires these three key components: a detailed interval history; a comprehensive examination; and medical decision making that is of low to moderate complexity. Usually, the patient is stable, recovering, or improving , 99305, 99306, 99307, 99308, 99309, 99310,99315, Domiciliary or rest home visit for the evaluation and management of a new patient which requires these 3 key components: a problem-focused history; a problem-focused examination; and, medical decision-making for a problem of low severity. (Approx 20 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 23 and documented in the Client's medical record Revised 10/3/2013

24 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Domiciliary or rest home visit for the evaluation and management of a new patient which requires these 3 key components: an expanded problemfocused history; an expanded problem-focused examination; and, medical decision-making for a moderately severe problem Domiciliary or rest home visit for the evaluation and management of a new patient which requires these 3 key components: a detailed history; a detailed examination; and, medical decision-making for a problem of high severity. (Approx. 50 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 24 and documented in the Client's medical record Revised 10/3/2013

25 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: a problem focused history; a problem focused examination; and straightforward medical decision making. Usually, the presenting problem(s) are of low severity. Physicians typically spend 20 minutes with the patient an/or family or caregiver Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes with the patient and/or family or caregiver. * Indicates service may be allowable in addition to HCTC if billed with an override 25 and documented in the Client's medical record Revised 10/3/2013

26 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: a detailed history; a detailed examination; and medical decision making of moderate complexity. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes with the patient and/or family or caregiver Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. Usually, the presenting problem(s) are of high severity. Physicians typically spend 60 minutes with the patient and/or family or caregiver. * Indicates service may be allowable in addition to HCTC if billed with an override 26 and documented in the Client's medical record Revised 10/3/2013

27 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Physicians typically spend 75 minutes with the patient and/or family or caregiver Domiciliary or rest home visit for the evaluation and management of an established patient which requires at least 2 of these 3 key components: a problem-focused interval history; a problem-focused examination; and, medical decision-making for a patient who is stable or improving. (Approx. 15 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 27 and documented in the Client's medical record Revised 10/3/2013

28 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Domiciliary or rest home visit for the evaluation and management of an established patient which requires at least 2 of these 3 key components: an expanded problem-focused interval history; an expanded problem-focused examination; and, decision-making for a patient who is responding inadequately or for a minor complication. (Approx. 25 minutes) Domiciliary or rest home visit for the evaluation and management of an established patient which requires at least 2 of these 3 key components: a detailed interval history; a detailed examination; and, decision-making regarding unstable patient/significant complication/new problem. (Approx. 35 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 28 and documented in the Client's medical record Revised 10/3/2013

29 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem focused interval history; a problem focused examination; straightforward medical decision making. Usually, the presenting problem(s) are self-limited or minor. Physicians typically spend 15 minutes with the patient and/or family or caregiver Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of low complexity. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 25 minutes with the patient and/or family or caregiver. * Indicates service may be allowable in addition to HCTC if billed with an override 29 and documented in the Client's medical record Revised 10/3/2013

30 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed interval history; a detailed examination; medical decision making of moderate complexity. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes with the patient and/or family or caregiver. Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: a comprehensive interval history; a comprehensive examination; and medical decision making of moderate to high complexity. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 60 minutes with the patient and/or family or caregiver. * Indicates service may be allowable in addition to HCTC if billed with an override 30 and documented in the Client's medical record Revised 10/3/2013

31 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Home visit for the evaluation and management of a new patient which requires these 3 key components: a problem-focused history; a problem focused examination; and medical decision-making for a low severity problem. (Approx. 20 minutes) Home visit for the evaluation and management of a new patient which requires 3 key components: an expanded problem-focused history; and expanded problem-focused examination; and medical decision-making for a moderately severe problem. (Approx. 35 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 31 and documented in the Client's medical record Revised 10/3/2013

32 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Home visit for the evaluation and management of a new patient which requires 3 key components: a detailed history; a detailed examination; and decision-making for a highly severe problem. (Approx. 45 minutes) Home visit for the evaluation and management of a new patient, which requires these three components: a comprehensive history; a comprehensive examination; and medical decision-making of moderate complexity. (Approx 60 min) * Indicates service may be allowable in addition to HCTC if billed with an override 32 and documented in the Client's medical record Revised 10/3/2013

33 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Home visit for the evaluation and management of a new patient, which requires these three components: a comprehensive history; a comprehensive examination; and medical decision-making of high complexity. (Approx 75 min) Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem focused interval history; a problem-focused examination; straightforward medical decision-making. (Approx 15 min) * Indicates service may be allowable in addition to HCTC if billed with an override 33 and documented in the Client's medical record Revised 10/3/2013

34 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision-making of low complexity. (Approx 25 min) Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed interval history; a detailed examination; medical decision-making of moderate complexity. (Approx 40 min) * Indicates service may be allowable in addition to HCTC if billed with an override 34 and documented in the Client's medical record Revised 10/3/2013

35 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: a comprehensive interval history; a comprehensive examination; medical decision-making of moderate to high complexity. (Approx 60 min) Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting); first hour. (List separately in addition to code for office or other outpatient evaluation and management service) * Indicates service may be allowable in addition to HCTC if billed with an override 35 and documented in the Client's medical record Revised 10/3/2013

36 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting). [Use for each additional 30 min in conjunction with 99354] H0001 Alcohol and/or drug assessment H0018 * Indicates service may be allowable in addition to HCTC if billed with an override 36 and documented in the Client's medical record Revised 10/3/2013

37 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0002 Behavioral health screening to determine eligibility for admission H0018 H0031 Mental health assessment / by Non-Physician H0018 * Indicates service may be allowable in addition to HCTC if billed with an override 37 and documented in the Client's medical record Revised 10/3/2013

38 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0004 Office, individual behavioral health counseling and therapy, per 15 minutes H0004 Home, individual behavioral health counseling and therapy, per 15 minutes * Indicates service may be allowable in addition to HCTC if billed with an override 38 and documented in the Client's medical record Revised 10/3/2013

39 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0004 Office, family behavioral health counseling and therapy with client present per 15 minutes HR H0004 Office, family behavioral health counseling and therapy without client present per 15 minutes HS * Indicates service may be allowable in addition to HCTC if billed with an override 39 and documented in the Client's medical record Revised 10/3/2013

40 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0004 Out of office, family behavioral health counseling and therapy with client present per 15 minutes HR H0004 Out of office, family behavioral health counseling and therapy without client present per 15 minutes HS * Indicates service may be allowable in addition to HCTC if billed with an override 40 and documented in the Client's medical record Revised 10/3/2013

41 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is bassed on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education H2033 H2033 Multisystemic therapy for juveniles, per 15 minutes H0015 Rehabilitation Services * Indicates service may be allowable in addition to HCTC if billed with an override 41 and documented in the Client's medical record Revised 10/3/2013

42 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2014 * Individual skills training and development, per 15 minutes H2017, H0018, S5109HB, S5109HC, S5109HA H2014 * Group skills training and development, per 15 minutes per person HQ H2017, H0018,, S5109HB, S5109HC, S5109HA * Indicates service may be allowable in addition to HCTC if billed with an override 42 and documented in the Client's medical record Revised 10/3/2013

43 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2017 * Psychosocial rehabilitation living skills training services, per 15 minutes H2014, H2014HQ, H0018, S5109HB, S5109HC, S5109HA H0025 Behavioral health prevention/promotion education service (services to target population to affect knowledge, attitude and/or behavior) H0018 * Indicates service may be allowable in addition to HCTC if billed with an override 43 and documented in the Client's medical record Revised 10/3/2013

44 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0034 Medication training and support H0018 H2025 Ongoing support to maintain employment, per 15 minutes H2026, H2027 * Indicates service may be allowable in addition to HCTC if billed with an override 44 and documented in the Client's medical record Revised 10/3/2013

45 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2026 Ongoing support to maintain employment, per diem H2025, H2027 H2027 Psychoeducational service (pre-job training and development), per 15 minutes H2025, H2026 * Indicates service may be allowable in addition to HCTC if billed with an override 45 and documented in the Client's medical record Revised 10/3/2013

46 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure T1002 RN services, up to 15 minutes T1003 LPN services, up to 15 minutes Support Services * Indicates service may be allowable in addition to HCTC if billed with an override 46 and documented in the Client's medical record Revised 10/3/2013

47 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure T1013 Sign language or oral interpretive services T1019 * Personal care service, per 15 minutes, not for inpatient or residential care facilities S5109HB, S5109HC, S5109HA, H0018, T1020 * Indicates service may be allowable in addition to HCTC if billed with an override 47 and documented in the Client's medical record Revised 10/3/2013

48 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure T1020 Personal care services, per diem, not for an inpatient or residential care facilities S5109HB, S5109HC, S5109HA, H0018, T1019, S5151 S5110 * Home care training, family; per 15 minutes S5109HB, S5109HC, S5109HA H0038 Self-help/peer services, per 15 minutes H2016 H2016 Comprehensive community support services, per diem H0038, H0038 HQ H0038 Self-help/peer services group, per 15 minutes HQ H2016 S5109HB Home care training to home care client, per session (adult) S5109HC, S5109HA, T1019, T1020, H0018, H2014, H2014HQ, H2017,S5110, S5151 * Indicates service may be allowable in addition to HCTC if billed with an override 48 and documented in the Client's medical record Revised 10/3/2013

49 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure S5109HC Home care training to home care client, per session (adult geriatric) S5109HB, S5109HA, T1019, T1020, H0018, H2014, H2014HQ, H2017,S5110, S5151 S5109HA Home care training to home care client, per session (child) S5109HB, S5109HC, T1019, T1020, H0018, H2014, H2014HQ, H2017, S5110, S5151 * Indicates service may be allowable in addition to HCTC if billed with an override 49 and documented in the Client's medical record Revised 10/3/2013

50 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure S5150 Unskilled respite care, not hospice; per 15 minutes H0018, S5151 S5151 Unskilled respite care, not hospice; per diem H0018, S5109HB, S5109HC, S5150, S5109HA Crisis Behavioral Health Services * Indicates service may be allowable in addition to HCTC if billed with an override 50 and documented in the Client's medical record Revised 10/3/2013

51 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure S9484 Crisis intervention mental health service, per hour S9485 S9485 Crisis intervention mental health service, per diem H0018, S9484 * Indicates service may be allowable in addition to HCTC if billed with an override 51 and documented in the Client's medical record Revised 10/3/2013

52 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2011 Crisis intervention service, per 15 minutes H2011 Crisis intervention service via 2 person team, per 15 minutes HT Behavioral Health Day Programs * Indicates service may be allowable in addition to HCTC if billed with an override 52 and documented in the Client's medical record Revised 10/3/2013

53 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2012 Supervised behavioral health day treatment, per hour H0018, H2015, H2019, H2019TF, H2020, H0036, H0036TF, H0037 H2015 Comprehensive community support services, supervised day program, per 15 minutes H0018, H2012, H2019, H2019TF, H2020, H0036, H0036TF, H0037 * Indicates service may be allowable in addition to HCTC if billed with an override 53 and documented in the Client's medical record Revised 10/3/2013

54 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2019 Therapeutic behavioral services day program, per 15 minutes H0018, H2012, H2015, H2019TF, H2020, H0036, H0036TF, H0037 H2019 Therapeutic behavioral services day program, per 15 minutes (min. of 3 hours and less than 6 hours) TF H0018, H2012, H2015, H2019, H2020, H0036, H0036TF, H0037 * Indicates service may be allowable in addition to HCTC if billed with an override 54 and documented in the Client's medical record Revised 10/3/2013

55 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2020 Therapeutic behavioral services, per diem H0018, H2012, H2015, H2019, H2019TF, H0036, H0037, H0036TF H0036 Community psychiatric supportive treatment day program, face-to-face, per 15 minutes H0018, H2012, H2015, H2019, H2019TF, H2020, H0036TF, H0037, * Indicates service may be allowable in addition to HCTC if billed with an override 55 and documented in the Client's medical record Revised 10/3/2013

56 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0036 Community psychiatric supportive treatment medical day program, face-toface, per 15 minutes TF H0018, H2012, H2015, H2019, H2019TF, H2020, H0036, H0037, H0037 Community psychiatric supportive treatment medical day program, per diem H0018, H2012, H2015, H2019, H2019TF, H2020, H0036, H0036TF Behavioral health day programs-home * Indicates service may be allowable in addition to HCTC if billed with an override 56 and documented in the Client's medical record Revised 10/3/2013

57 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2019 Home therapeutic behavioral services day program, per 15 minutes TF H0018, H2012, H2015, H2019, H2020, H0036, H0036TF, H0037 H2020 Home therapeutic behavioral health day services, per diem H0018, H2012, H2015, H2019, H2019TF, H0036, H0036TF, H0037 * Indicates service may be allowable in addition to HCTC if billed with an override 57 and documented in the Client's medical record Revised 10/3/2013

58 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0036 Home community psychiatric supportive medical treatment, face-to-face, per 15 minutes H0018, H2012, H2015, H2019, H2019TF, H2020, H0036TF, H0037 H0036 Home community psychiatric supportive medical treatment, face-to-face, per 15 minutes TF H0018, H2012, H2015, H2019, H2019TF, H2020, H0036, H0037 * Indicates service may be allowable in addition to HCTC if billed with an override 58 and documented in the Client's medical record Revised 10/3/2013

59 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0037 Home community psychiatric supportive medical treatment program, per diem H0018, H2012, H2015, H2019, H2019TF, H2020, H0036, H0036TF Residential Services H0043 Supported Housing H0018 * Indicates service may be allowable in addition to HCTC if billed with an override 59 and documented in the Client's medical record Revised 10/3/2013

60 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0018 Behavioral health; short-term residential, without room and board H0001, H0002, H0025, H0031, H0034, H0037, H0043, H2012, H2014, H2014HQ, H2015, H2017, H2019, T1019, T1020, S5109HB, S5109HC, S5109HA, S5150, S5151, H2019TF, H2020, H0036, H0036TF, S9485 * Indicates service may be allowable in addition to HCTC if billed with an override 60 and documented in the Client's medical record Revised 10/3/2013

Crosswalk of 2012 CPT 4 codes to 2013 CPT 4 codes

Crosswalk of 2012 CPT 4 codes to 2013 CPT 4 codes The following code changes for behavioral health are effective January 1, 2013. Crosswalk of 2012 CPT 4 codes to 2013 CPT 4 codes 2012 Code (Deleted as of January 1, 2013) 90801 Psychiatric diagnostic

More information

Untimed Billing Procedure CPT Codes Effective February 1, 2010

Untimed Billing Procedure CPT Codes Effective February 1, 2010 20552 Therapeutic injections: Tendons, trigger points single or multiple trigger points; 1 or 2 muscles 20553 Therapeutic injections: Tendons, trigger points single or multiple trigger points; 3 or more

More information

APPROVED HCPCS AND CPT CODES AND MODIFIERS RELATING TO SUBSTANCE ABUSE TREATMENT, MENTAL HEALTH, AND BEHAVIORAL HEALTH 1 (As of April 1, 2003)

APPROVED HCPCS AND CPT CODES AND MODIFIERS RELATING TO SUBSTANCE ABUSE TREATMENT, MENTAL HEALTH, AND BEHAVIORAL HEALTH 1 (As of April 1, 2003) APPROVED HCPCS AND CPT CODES AND MODIFIERS RELATING TO SUBSTANCE ABUSE TREATMENT, MENTAL HEALTH, AND BEHAVIORAL HEALTH 1 (As of April 1, 2003) G0176 G0177 H0001 CODE Description Activity therapy, such

More information

Examples of States Billing Codes for Mental Health Services, Publicly Funded

Examples of States Billing Codes for Mental Health Services, Publicly Funded Examples of States Billing Codes for Mental Health Services, Publicly Funded Written by Shelagh Smith, MPH, CHES, SAMHSA s Center for Mental Health Services Complied by Eileen Charneco, SAMHSA Intern December

More information

Provider Type 14 Billing Guide

Provider Type 14 Billing Guide State policy The Medicaid Services Manual (MSM) is on the Division of Health Care Financing and Policy (DHCFP) website at http://dhcfp.nv.gov (select Manuals from the Resources webpage). MSM Chapter 400

More information

This CPT code information was copied from Cigna Provider's website 7/20/2006. -jon

This CPT code information was copied from Cigna Provider's website 7/20/2006. -jon This CPT code information was copied from Cigna Provider's website 7/20/2006. -jon Psychiatric Diagnostic or Evaluative Interview Procedures 90801 psychiatric diagnostic interview examination 90802 interactive

More information

OBSERVATION CARE EVALUATION AND MANAGEMENT CODES

OBSERVATION CARE EVALUATION AND MANAGEMENT CODES REIMBURSEMENT POLICY OBSERVATION CARE EVALUATION AND MANAGEMENT CODES Policy Number: ADMINISTRATIVE 232.8 T0 Effective Date: April, 205 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION...

More information

VALID PRIMARY DIAGNOSIS CODES FOR SUBSTANCE ABUSE HCPCS CODES

VALID PRIMARY DIAGNOSIS CODES FOR SUBSTANCE ABUSE HCPCS CODES SUBSTANCE ABUSE HCPCS CODES THESE CODES CANNOT BE BILLED ON THE SAME CLAIM WITH THE LIST (A) CODES FROM LIST (B) H0010 Alcohol and/or drug (Inpatient)sub-acute H0011 Alcohol and/or drug (Inpatient)acute

More information

Medicaid Services for Substance Abuse

Medicaid Services for Substance Abuse Medicaid Services for Substance Abuse Community Behavioral Health Services Coverage and Limitations Handbook 2007 FADAA Annual Conference-Orlando Making Medicaid Work for Substance Abuse Agenda Overview

More information

CPT Code Changes for 2013 (Behavioral Health)

CPT Code Changes for 2013 (Behavioral Health) CPT Code Changes for 2013 (Behavioral Health) Overview Effective January 1, 2013 there will be changes to some Current Procedural Terminology (CPT) codes deleted codes and replacement codes. The list of

More information

INPATIENT CONSULTATIONS

INPATIENT CONSULTATIONS INPATIENT CONSULTATIONS REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 228.7 T0 Effective Date: February, 20 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT

More information

NM Behavioral Health Design Service List By HIPAA Code and Definition. Modifiers Service Definition Unit Comments

NM Behavioral Health Design Service List By HIPAA Code and Definition. Modifiers Service Definition Unit Comments CPT 90801 H9, TR, HA Psychiatric diagnostic interview examination Psychiatric diagnostic interview examination includes a history, mental status, and a disposition, and may include communication with family

More information

Alcohol and Drug Rehabilitation Providers

Alcohol and Drug Rehabilitation Providers June 2009 Provider Bulletin Number 942 Alcohol and Drug Rehabilitation Providers New Modifier and s for Substance Abuse Services Effective with dates of service on and after July 1, 2009, eligible substance

More information

Coding and Billing. General Office Billing Guidelines Scroll to page 1. Key Terms.. Scroll to page 2

Coding and Billing. General Office Billing Guidelines Scroll to page 1. Key Terms.. Scroll to page 2 OVER VEIW General Office Billing Guidelines Scroll to page 1 Key Terms.. Scroll to page 2 Coding for Evaluation and Management Services..Scroll to page 2 Frequently Used Common Procedural Codes.. Scroll

More information

Oregon Health Plan - Fee-For-Service Outpatient & Opioid Replacement

Oregon Health Plan - Fee-For-Service Outpatient & Opioid Replacement Oregon Health Plan - Fee-For-Service Outpatient & Opioid Replacement H0001 H0002T Alcohol and/or Drug Assessment $139.70 One assessment equals one unit of service. Service frequency limitation is based

More information

Important Update Regarding Behavioral Health CPT Codes and Pre-Certification Rules

Important Update Regarding Behavioral Health CPT Codes and Pre-Certification Rules Important Update Regarding Behavioral Health CPT Codes and Pre-Certification Rules Summary of change: Effective for dates of service on and after 1/1/2014, Amerigroup is updating the Amerigroup Georgia

More information

Procedure/ Revenue Code. Billing NPI Required. Rendering NPI Required. Service/Revenue Code Description. Yes No No

Procedure/ Revenue Code. Billing NPI Required. Rendering NPI Required. Service/Revenue Code Description. Yes No No Procedure/ Revenue Code Service/Revenue Code Description Billing NPI Rendering NPI Attending/ Admitting NPI 0100 Inpatient Services Yes No Yes 0114 Room & Board - private psychiatric Yes No Yes 0124 Room

More information

DDaP Service Codes. Page 1 of 27

DDaP Service Codes. Page 1 of 27 90782 Injection SC/IM Therapeutic or diagnostic injection(specify material injected)subcutaneous or intramuscular. Service s per incident same same same 90782 Injection SC/IM By Nurse Therapeutic or diagnostic

More information

CPT Coding Changes for 2013

CPT Coding Changes for 2013 CPT Coding Changes for 2013 Getting Prepared Presenter Ronald Burd, MD Psychiatrist, Stanford Health, Fargo, ND Chair, APA Committee on Codes, RBRVS and Reimbursements APA Representative, AMA s RBRVS Update

More information

Observation Care Evaluation and Management Codes Policy

Observation Care Evaluation and Management Codes Policy Policy Number REIMBURSEMENT POLICY Observation Care Evaluation and Management Codes Policy 2016R0115A Annual Approval Date 3/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT

More information

other caregivers. A beneficiary may receive one diagnostic assessment per year without any additional authorization.

other caregivers. A beneficiary may receive one diagnostic assessment per year without any additional authorization. 4.b.(8) Diagnostic, Screening, Treatment, Preventive and Rehabilitative Services (continued) Attachment 3.1-A.1 Page 7c.2 (a) Psychotherapy Services: For the complete description of the service providers,

More information

SUBSTANCE ABUSE ENCOUNTER REPORTING: HCPCS and Revenue Codes Overview of Updates for Fiscal Year 2008

SUBSTANCE ABUSE ENCOUNTER REPORTING: HCPCS and Revenue Codes Overview of Updates for Fiscal Year 2008 SUBSTANCE ABUSE ENCOUNTER REPORTING: HCPCS and Overview of Updates for Fiscal Year 2008 This encounter code and modifier chart, effective 10/1/2007, describes how submitted encounter codes and modifiers

More information

99-04 - 06 Attachment A

99-04 - 06 Attachment A 99-04 - 06 Attachment A Description Definition 92507 Speech and Language Therapy - 92507 Treatment of Speech, language, voice, communication and/or auditory processing disorder (Includes aural 97532 Cognitive

More information

OPTUM By United Behavioral Health OPTUM GUIDELINE EVIDENCE BASE: Level of Care Guidelines

OPTUM By United Behavioral Health OPTUM GUIDELINE EVIDENCE BASE: Level of Care Guidelines OPTUM By United Behavioral Health OPTUM GUIDELINE EVIDENCE BASE: Level of Care Guidelines Guideline Evaluation and Treatment Planning Discharge Planning Admission Criteria Continued Stay Criteria Discharge

More information

State of Illinois Community Mental Health Services Service Definition and Reimbursement Guide

State of Illinois Community Mental Health Services Service Definition and Reimbursement Guide Effective July 1, 2007 Contents Page Alphabetic list of s iii General notes iv Group A s (132.148) A-1 Mental health assessment A-2 Psychological evaluation A-3 Treatment plan development, review and modification

More information

MEDICAL POLICY No. 91607-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD AND ADOLESCENT

MEDICAL POLICY No. 91607-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD AND ADOLESCENT Summary of Changes MEDICAL POLICY MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD ADOLESCENT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 14, 2014 Status: Current Clarifications:

More information

2013 CPT Coding Changes Psychiatry

2013 CPT Coding Changes Psychiatry 2013 CPT Coding Changes Psychiatry CPT made dramatic changes to this coding section to better reflect the different work performed by physicians and other healthcare professionals and to capture changes

More information

New Patient Visit. UnitedHealthcare Medicare Reimbursement Policy Committee

New Patient Visit. UnitedHealthcare Medicare Reimbursement Policy Committee New Patient Visit Policy Number NPV04242013RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 12/16/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to

More information

Medical Necessity and Level of Care Determination Criteria

Medical Necessity and Level of Care Determination Criteria Medical Necessity and Level of Care Determination Criteria The current version of this document is the online version. It can be found at priorityhealth.com/provider/manual/auths/bh/mednecessity/. Priority

More information

LEVEL III.5 SA: SHORT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE)

LEVEL III.5 SA: SHORT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE) LEVEL III.5 SA: SHT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE) Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance-Related Disorders

More information

Division of Behavioral Health. Requirements for Program Staff

Division of Behavioral Health. Requirements for Program Staff Division of Behavioral Health Requirements for Program Staff Integrated BH Regulations Training 1 Program Staff Program Staff are professionals who render behavioral health services directly to a recipient.

More information

Behavioral Health Covered Services & Authorization Guidelines Florida Managed Medical Assistance (MMA) & Child Welfare (CW)

Behavioral Health Covered Services & Authorization Guidelines Florida Managed Medical Assistance (MMA) & Child Welfare (CW) Behavioral Health Covered Services & Authorization Guidelines Florida Managed Medical Assistance (MMA) & Child Welfare (CW) Please refer to your Agreement with Cenpatico to identify additional services

More information

Appendix D. Behavioral Health Partnership. Adolescent/Adult Substance Abuse Guidelines

Appendix D. Behavioral Health Partnership. Adolescent/Adult Substance Abuse Guidelines Appendix D Behavioral Health Partnership Adolescent/Adult Substance Abuse Guidelines Handbook for Providers 92 ASAM CRITERIA The CT BHP utilizes the ASAM PPC-2R criteria for rendering decisions regarding

More information

Florida Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida

Florida Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida As of July 2003 2,441,266 people were covered under Florida's Medicaid and SCHIP programs. There were 2,113,820 enrolled in the

More information

Important Update Regarding Precertification and Behavioral Health CPT Codes

Important Update Regarding Precertification and Behavioral Health CPT Codes Important Update Regarding Precertification and Behavioral Health CPT Codes Summary of change: Effective April 11, 2014, psychotherapy services beyond the first 10 sessions rendered in a member s home

More information

Question and Answer Submissions

Question and Answer Submissions AACE Endocrine Coding Webinar Welcome to the Brave New World: Billing for Endocrine E & M Services in 2010 Question and Answer Submissions Q: If a patient returns after a year or so and takes excessive

More information

2013 CPT CODE CHANGES for NYS OMH Licensed Clinics. New York State Office of Mental Health December 13, 2012

2013 CPT CODE CHANGES for NYS OMH Licensed Clinics. New York State Office of Mental Health December 13, 2012 2013 CPT CODE CHANGES for NYS OMH Licensed Clinics New York State Office of Mental Health December 13, 2012 Background New Psychiatric CPT codes published by AMA Compliance mandatory under federal law

More information

NEW YORK STATE MEDICAID PROGRAM NURSE PRACTITIONER PROCEDURE CODES

NEW YORK STATE MEDICAID PROGRAM NURSE PRACTITIONER PROCEDURE CODES NEW YORK STATE MEDICAID PROGRAM NURSE PRACTITIONER PROCEDURE CODES Table of Contents GENERAL INFORMATION... 3 STATE DEPARTMENT OF HEALTH CONDITIONS FOR PAYMENT... 6 PRACTITIONER SERVICES PROVIDED IN HOSPITALS...

More information

EXTENDED HOURS HOME CARE SKILLED (PRIVATE DUTY) NURSING

EXTENDED HOURS HOME CARE SKILLED (PRIVATE DUTY) NURSING Status Active Medical and Behavioral Health Policy Section: Skilled Services Policy Number: IX-01 Effective Date: 04/23/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members

More information

GENERAL INSTRUCTIONS

GENERAL INSTRUCTIONS This section provides definitions and general instructions for the Montana Substance Abuse Management System (SAMS). Subject areas include system overview, program requirements, system components and general

More information

Partial Hospitalization - MH - Adult (Managed Medicaid only Service)

Partial Hospitalization - MH - Adult (Managed Medicaid only Service) Partial Hospitalization - MH - Adult (Managed Medicaid only Service) Definition Partial hospitalization is a nonresidential treatment program that is hospital-based. The program provides diagnostic and

More information

Medicaid Made Friendly for Substance Abuse Treatment Providers

Medicaid Made Friendly for Substance Abuse Treatment Providers Medicaid Made Friendly for Substance Abuse Treatment Providers Exploring Revenue Maximization Opportunities and Strategies Mary Herkert mherkert@cfbhn.org Agenda Multi-System Funding Medicaid vs Licensure

More information

POLICY AND METHODS FOR ESTABLISHING PAYMENT RATES FOR OTHER TYPES OF CARE FOR SERVICES

POLICY AND METHODS FOR ESTABLISHING PAYMENT RATES FOR OTHER TYPES OF CARE FOR SERVICES Attachment 4.19-B Page 1a-1 POLICY AND METHODS FOR ESTABLISHING PAYMENT RATES FOR OTHER TYPES OF CARE FOR SERVICES C. Community Behavioral Health Rehabilitation Services Effective for services provided

More information

All payment rates and their effective dates shall be reflected in the Division's website at www.med-quest.us.

All payment rates and their effective dates shall be reflected in the Division's website at www.med-quest.us. ATTACHMENT 4.19-B State: HAWAII NONINSTITUTIONAL ITEMS AND SERVICES: The State assures that the reimbursement to public and private providers of Medicaid services, products or items are the same and does

More information

Mental Health and Substance Abuse Reporting Requirements Section 425 of P.A. 154 of 2005

Mental Health and Substance Abuse Reporting Requirements Section 425 of P.A. 154 of 2005 Mental Health and Substance Abuse Reporting Requirements Section 425 of P.A. 154 of 2005 By April 1, 2006, the Department, in conjunction with the Department of Corrections, shall report the following

More information

Non-Physician Practitioner Services Coding & Reporting. Karla R. Peter, RHIT, CCS, CCS-P, CPC Avera Health September 6, 2013

Non-Physician Practitioner Services Coding & Reporting. Karla R. Peter, RHIT, CCS, CCS-P, CPC Avera Health September 6, 2013 Non-Physician Practitioner Services Coding & Reporting Karla R. Peter, RHIT, CCS, CCS-P, CPC Avera Health September 6, 2013 Medical Necessity Overarching Criterion Medicare Claims Processing Manual, Chapter

More information

Behavioral Health Medical Necessity Criteria

Behavioral Health Medical Necessity Criteria Behavioral Health Medical Necessity Criteria Revised: 7/14/05 2 nd Revision: 9/14/06 3 rd Revision: 8/23/07 4 th Revision: 8/28/08; 11/20/08 5 th Revision: 8/27/09 Anthem Blue Cross and Blue Shield 2 Gannett

More information

PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER CLINICAL PRIVILEGES

PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER CLINICAL PRIVILEGES Name: Page 1 Initial Appointment Reappointment Department Specialty Area All new applicants must meet the following requirements as approved by the governing body effective: 6/3/15 Applicant: Check off

More information

BEHAVIORAL MEDICINE CODING AND BILLING GUIDE DEVELOPED: FEBRUARY 2005

BEHAVIORAL MEDICINE CODING AND BILLING GUIDE DEVELOPED: FEBRUARY 2005 BEHAVIORAL MEDICINE CODING AND BILLING GUIDE DEVELOPED: FEBRUARY 2005 This is a matrix of basic coding and billing information, arranged by payer, for coding and billing guidance. It should be used in

More information

Place of Service Codes for Professional Claims Database (updated November 1, 2012)

Place of Service Codes for Professional Claims Database (updated November 1, 2012) Place of Codes for Professional Claims Database (updated November 1, 2012) Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity

More information

ACUTE TREATMENT SERVICES (ATS) FOR SUBSTANCE USE DISORDERS LEVEL III.7

ACUTE TREATMENT SERVICES (ATS) FOR SUBSTANCE USE DISORDERS LEVEL III.7 ACUTE TREATMENT SERVICES (ATS) FOR SUBSTANCE USE DISORDERS LEVEL III.7 Providers contracted for this level of care or service are expected to comply with all requirements of these service-specific performance

More information

Place of Service Codes for Professional Claims Database (updated August 6, 2015)

Place of Service Codes for Professional Claims Database (updated August 6, 2015) Place of Codes for Professional Claims Database (updated August 6, 2015) Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity

More information

Diagnostic, Screening, Treatment, Preventive and Rehabilitative Services

Diagnostic, Screening, Treatment, Preventive and Rehabilitative Services Page 7c.1 4.b(8) Diagnostic, Screening, Treatment, Preventive and Rehabilitative Services Services provided under this section are provided by licensed practitioners (within their scope of practice as

More information

4. Program Regulations

4. Program Regulations Table of Contents iv 437.401: Introduction... 4-1 437.402: Definitions... 4-1 437.403: Eligible Members... 4-2 437.404: Provider Eligibility... 4-3 437.405: Out-of-State Hospice Services... 4-3 437.406:

More information

HOSPICE SERVICES. This document is subject to change. Please check our web site for updates.

HOSPICE SERVICES. This document is subject to change. Please check our web site for updates. HOSPICE SERVICES This document is subject to change. Please check our web site for updates. This provider manual outlines policy and claims submission guidelines for claims submitted to the North Dakota

More information

Table of Contents Forward... 1 Introduction... 2 Evaluation and Management Services... 3 Psychiatric Services... 6 Diagnostic Surgery and Surgery...

Table of Contents Forward... 1 Introduction... 2 Evaluation and Management Services... 3 Psychiatric Services... 6 Diagnostic Surgery and Surgery... Table of Contents Forward... 1 Introduction... 2 Evaluation and Management Services... 3 Psychiatric Services... 6 Diagnostic Surgery and Surgery... 6 Other Complex or High Risk Procedures... 7 Radiology,

More information

73.84 49.27 73.84 73.84

73.84 49.27 73.84 73.84 OTHER PROFESSIONAL SERVICES FOR IOP, PHP & CRS 90791 Psychiatric diagnostic evaluation 154.71 108.13 125.97 110.29 177.20 90791 C&A Psychiatric diagnostic evaluation 154.71 108.13 125.97 110.29 197.91

More information

COVERED BEHAVIORAL HEALTH SERVICES GUIDE

COVERED BEHAVIORAL HEALTH SERVICES GUIDE ARIZONA DEPARTMENT OF HEALTH SERVICES DIVISION OF BEHAVIORAL HEALTH SERVICES COVERED BEHAVIORAL HEALTH SERVICES GUIDE Release date September 1, 2001 Applicable for Services Provided on 10/03/01 or later

More information

Seniors Health Services

Seniors Health Services Leading the way in care for seniors Seniors Health Services Capital Health offers a variety of services to support seniors in communities across the region. The following list highlights programs and services

More information

Billing and Coding Update in the Nursing Home 2015

Billing and Coding Update in the Nursing Home 2015 Billing and Coding Update in the Nursing Home 2015 Charles Crecelius MD PhD FACP CMD Agenda Review of nursing home basic coding requirements Use of NPP New Transition of Care code Ancillary CPT codes,

More information

NEW YORK STATE MEDICAID PROGRAM MIDWIFE PROCEDURE CODES

NEW YORK STATE MEDICAID PROGRAM MIDWIFE PROCEDURE CODES NEW YORK STATE MEDICAID PROGRAM MIDWIFE PROCEDURE CODES Table of Contents GENERAL INFORMATION... 3 SERVICES PROVIDED IN ARTICLE 28 FACILITIES... 4 MMIS MODIFIERS... 4 MEDICINE SECTION... 7 GENERAL INFORMATION

More information

Place of Service Codes for Professional Claims Database (updated November 1, 2012)

Place of Service Codes for Professional Claims Database (updated November 1, 2012) Codes for Professional Claims Database (updated November 1, 2012) Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity where

More information

Ryan White Program Services Definitions

Ryan White Program Services Definitions Ryan White Program Services Definitions CORE SERVICES Service categories: a. Outpatient/Ambulatory medical care (health services) is the provision of professional diagnostic and therapeutic services rendered

More information

Acute Care & Outpatient Facility Services. Facility 101, 110, 114, 124, 134, 21, 51, 55, 56 Yes. Facility 905, 906 22, 52, L

Acute Care & Outpatient Facility Services. Facility 101, 110, 114, 124, 134, 21, 51, 55, 56 Yes. Facility 905, 906 22, 52, L Behavioral Health Covered Services & orization Guidelines Ohio Covered Families and Children (CFC), Age Blind and Disabled (ABD) and Ohio MyCare Medicare/Medicaid (MMP) Please refer to your Agreement with

More information

Coding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care

Coding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care p` P R A C T I C E R E S O U R C E NO.2 A PRIL 2 0 1 6 U P D A T E Coding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care Margaret McManus, MHS The National Alliance to Advance

More information

MEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT

MEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 12, 2014 Status: Current Summary of Changes Clarifications: Pg 4, Description, updated

More information

AHCCCS Billing Manual for IHS/Tribal Providers April, 2004 Behavioral Health Services Chapter: 12 Page: 12-1

AHCCCS Billing Manual for IHS/Tribal Providers April, 2004 Behavioral Health Services Chapter: 12 Page: 12-1 Chapter: 12 Page: 12-1 GENERAL INFORMATION NOTE: Coverage and reimbursement for both Title XIX (Medicaid-AHCCCS) and Title XXI (KidsCare) services are explained in this chapter. The covered services, limitations,

More information

Targeted Case Management Services

Targeted Case Management Services Targeted Case Management Services 2013 Acronyms and Abbreviations AHCA Agency for Health Care Administration MMA Magellan Medicaid Administration CBC Community Based Care CBH Community Behavioral Health

More information

Day Treatment Mental Health Adult

Day Treatment Mental Health Adult Day Treatment Mental Health Adult Definition Day Treatment provides a community based, coordinated set of individualized treatment services to individuals with psychiatric disorders who are not able to

More information

NC ADATC Service. NC Coalition for MH/DD/SAS By Division of State Operated Healthcare Facilities February, 2015 DSOHF ADATC 2.

NC ADATC Service. NC Coalition for MH/DD/SAS By Division of State Operated Healthcare Facilities February, 2015 DSOHF ADATC 2. NC ADATC Service NC Coalition for MH/DD/SAS By Division of State Operated Healthcare Facilities February, 2015 DSOHF ADATC 2.2015 1 Individuals in Need of Services Q3, SFY13, Community Systems Progress

More information

LEVEL III.1 SA: HALFWAY HOUSE - Adult

LEVEL III.1 SA: HALFWAY HOUSE - Adult LEVEL III.1 SA: HALFWAY HOUSE - Adult Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance-Related Disorders of the American Society

More information

Benefit Plan Comparison*

Benefit Plan Comparison* Benefit Plan Comparison* Services Category 1: Ambulatory Services Primary Care Provider Physician Office Certified Registered Nurse Practitioner Federally Qualified Health Center/Rural Health Clinic except

More information

New Medi-Cal Behavioral Health Benefits

New Medi-Cal Behavioral Health Benefits New Medi-Cal Behavioral Health Benefits Brief History 2004 2008 2010 1/1/2014 ACA Medi-Cal Expansion & LIHP Transition 1 Eligible Populations Traditional Medi-Cal Age 65 or older Under age 21 An adult,

More information

TREATMENT MODALITIES. May, 2013

TREATMENT MODALITIES. May, 2013 TREATMENT MODALITIES May, 2013 Treatment Modalities New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) regulates the addiction treatment modalities offered in New York State.

More information

Subacute Inpatient MH - Adult

Subacute Inpatient MH - Adult Subacute Inpatient MH - Adult Definition Subacute Inpatient hospital psychiatric services are medically necessary short-term psychiatric services provided to a client with a primary psychiatric diagnosis

More information

None. services will be provided through the Department s BHSA, Magellan. Magellan care managers are all licensed mental health professionals.

None. services will be provided through the Department s BHSA, Magellan. Magellan care managers are all licensed mental health professionals. Serious Mental Illness (SMI) Eligibility Screenings SMI Eligibility Screenings (short and long) will be performed as part of the GAP eligibility process, and can be performed by Community Services Boards,

More information

Place of Service Codes

Place of Service Codes Place of Service Codes Code(s) Place of Service Name Place of Service Description 01 Pharmacy** A facility or location where drugs and other medically related items and services are sold, dispensed, or

More information

Oregon Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Oregon

Oregon Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Oregon Mental Health and Substance Abuse Services in Medicaid and SCHIP in Oregon As of July 2003, 398,874 people were covered under Oregon s Medicaid/SCHIP programs. There were 380,546 enrolled in the Medicaid

More information

General Hospital Information

General Hospital Information Inpatient Programs General Hospital Information General Information The Melbourne Clinic is a purpose built psychiatric hospital established in 1975, intially privately owned by a group of psychiatrists

More information

Federal Purpose Area 5 Drug Treatment Programs

Federal Purpose Area 5 Drug Treatment Programs Federal Purpose Area 5 Drug Treatment Programs State Purpose Areas: 11F Mental Health Services 11F.01 Provide mental health services through various treatment modalities to a specified number of clients.

More information

Coding for Evaluation and Management Services

Coding for Evaluation and Management Services Coding for Evaluation and Management Services Joanne Mehmert, CPC Joanne Mehmert & Associates, LLC fmeh@aol.com 2006 CPT E&M Updates May 2006 2 1 E&M Deleted Codes Deleted codes 99261-99263 Follow-up consultation

More information

NEW YORK STATE MEDICAID PROGRAM PHYSICIAN PROCEDURE CODES. SECTION 2 MEDICINE, DRUGS and DRUG ADMINISTRATION

NEW YORK STATE MEDICAID PROGRAM PHYSICIAN PROCEDURE CODES. SECTION 2 MEDICINE, DRUGS and DRUG ADMINISTRATION NEW YORK STATE MEDICAID PROGRAM PHYSICIAN PROCEDURE CODES SECTION 2 MEDICINE, DRUGS and DRUG ADMINISTRATION Table of Contents GENERAL RULES AND INFORMATION... 3 MMIS MODIFIERS... 15 EVALUATION AND MANAGEMENT

More information

American Society of Addiction Medicine

American Society of Addiction Medicine American Society of Addiction Medicine Public Policy Statement on Treatment for Alcohol and Other Drug Addiction 1 I. General Definitions of Addiction Treatment Addiction Treatment is the use of any planned,

More information

HIPAA Code Conversions

HIPAA Code Conversions North Carolina Medicaid Special Bulletin An Information Service of the Division of Medical Assistance Published by EDS, fiscal agent for the North Carolina Medicaid Program Number IV November 2003 Attention:

More information

Frequently Asked Questions about Fee-for-Service Medicare For People with Alzheimer s Disease

Frequently Asked Questions about Fee-for-Service Medicare For People with Alzheimer s Disease Frequently Asked Questions about Fee-for-Service Medicare For People with Alzheimer s Disease This brochure answers questions Medicare beneficiaries with Alzheimer s disease, and their families, may have

More information

Complex Continuing Care Restorative Care (Combined Functional Enhancement and Restorative Care Programs)

Complex Continuing Care Restorative Care (Combined Functional Enhancement and Restorative Care Programs) Complex Continuing Care Restorative Care (Combined Functional Enhancement and Restorative Care Programs) Description: The Restorative Care program provides a moderate to low intensity goal-oriented rehabilitation

More information

CONTRACT BILLING MANUAL

CONTRACT BILLING MANUAL ALABAMA DEPARTMENT OF MENTAL HEALTH MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES DIVISION CONTRACT BILLING MANUAL EFFECTIVE JULY 1, 2013 (Revised September 9, 2013) SERVICES TABLE OF CONTENT BEHAVIORAL HEALTH

More information

May 21, 2015 Joint Committee on Finance Paper #352

May 21, 2015 Joint Committee on Finance Paper #352 Legislative Fiscal Bureau One East Main, Suite 301 Madison, WI 53703 (608) 266-3847 Fax: (608) 267-6873 Email: fiscal.bureau@legis.wisconsin.gov Website: http://legis.wisconsin.gov/lfb May 21, 2015 Joint

More information

Hamilton Health Sciences Acquired Brain Injury Program

Hamilton Health Sciences Acquired Brain Injury Program Overview of Program The Acquired Brain Injury (ABI) Program at the Regional Rehabilitation Centre, Hamilton General Hospital serve the rehabilitation needs of adults with acquired brain injuries and their

More information

SECTION VII: Behavioral Health Services

SECTION VII: Behavioral Health Services OVERVIEW Behavioral Health Services (mental health and/or substance abuse services) are covered for all members except those enrolled in family planning services only. Care1st manages the delivery of select

More information

For Family Caregivers: Leaving the Hospital and Going Where?

For Family Caregivers: Leaving the Hospital and Going Where? Family Caregiver Guide For Family Caregivers: Leaving the Hospital and Going Where? Planning for care after a discharge is often stressful. A thoughtful discussion with a knowledgeable professional can

More information

114.3 CMR 52.00: RATES OF PAYMENT FOR CERTAIN CHILDREN S BEHAVIORAL HEALTH SERVICES

114.3 CMR 52.00: RATES OF PAYMENT FOR CERTAIN CHILDREN S BEHAVIORAL HEALTH SERVICES Section 52.01: General Provisions 52.02: General Definitions 52.03: Rate Provisions 52.04: Reporting Requirements and Sanctions 52.05: Severability 52.01: General Provisions (1) Scope, Purpose and Effective

More information

Mental Hygiene Administration Public Mental Health System Dual Diagnosis Consumer Count and Expenditures by Service Category and Age Group

Mental Hygiene Administration Public Mental Health System Dual Diagnosis Consumer Count and Expenditures by Service Category and Age Group Dual Diagnosis and by and Group 2006 % of % of Case Management Crisis Inpatient Mobile Treatment Outpatient Partial Hospitalization Psychiatric Rehabilitation Residential Rehabilitation Residential Treatment

More information

ANNEX A1 DMHAS ASAM SERVICE DESCRIPTIONS

ANNEX A1 DMHAS ASAM SERVICE DESCRIPTIONS DMHAS ASAM SERVICE DESCRIPTIONS Please carefully review the Service Descriptions that are included in the DMHAS FFS Initiatives in this Annex A1 contract section. Initial the boxes below to identify the

More information

Psychiatric Day Rehabilitation MH - Adult

Psychiatric Day Rehabilitation MH - Adult Psychiatric Day Rehabilitation MH - Adult Definition Day Rehabilitation services are designed to provide individualized treatment and recovery, inclusive of psychiatric rehabilitation and support for clients

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: private_duty_nursing_services 11/3/2005 2/2016 2/2017 2/2016 Description of Procedure or Service Private

More information

SCHEDULE OF CHARGES APPROVED BY CHESAPEAKE INTEGRATED BEHAVIORAL HEALTHCARE BOARD OF DIRECTORS Effective 7/1/2015 MENTAL HEALTH SERVICES

SCHEDULE OF CHARGES APPROVED BY CHESAPEAKE INTEGRATED BEHAVIORAL HEALTHCARE BOARD OF DIRECTORS Effective 7/1/2015 MENTAL HEALTH SERVICES SCHEDULE OF CHARGES APPROVED BY CHESAPEAKE INTEGRATED BEHAVIORAL HEALTHCARE BOARD OF DIRECTORS Effective 7/1/2015 MENTAL HEALTH S ACR Assessment Initial Assessment - Full $ 100.00 ACR Assessment Annual

More information

Professional Treatment Services in Facility-Based Crisis Program Children and Adolescents

Professional Treatment Services in Facility-Based Crisis Program Children and Adolescents Professional Treatment Services in Facility-Based Crisis Program Children and Adolescents Medicaid and North Carolina Health Choice (NCHC) Billable Service WORKING DRAFT Revision Date: September 11, 2014

More information

CPT Code Changes for 2013 Frequently Asked Questions Last Updated 3/7/2013

CPT Code Changes for 2013 Frequently Asked Questions Last Updated 3/7/2013 CPT Code Changes for 2013 Frequently Asked Questions Last Updated 3/7/2013 Contents Background... 1 Reporting Deviations from CPT Guidelines... 3 Psychotherapy Services... 3 Pharmacologic Management...

More information

Benefit Plan Comparison* Services Category 1: Ambulatory Services Primary Care Provider Physician Office Certified Registered Nurse Practitioner Federally Qualified Health Center/Rural Health Clinic except

More information